| NPI | 1720198351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 264764) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: MA 264764) |
| 207R00000X Internal Medicine (Licence: VT 0420008682) | |
| 207RA0000X Internal Medicine Adolescent Medicine (Licence: VT 0420008682) | |
| 207RH0002X Internal Medicine Hospice and Palliative Medicine (Licence: MA 264764) | |
| 207RH0002X Internal Medicine Hospice and Palliative Medicine (Licence: VT 0420008682) | |
| 208000000X Pediatrics (Licence: MA 264764) | |
| 208000000X Pediatrics (Licence: VT 0420008682) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-10-25 |